ClickCare Café

Why Medical Collaboration Can Help Us Lead With Our Values

Posted by Lawrence Kerr on Wed, Dec 05, 2018 @ 09:41 AM

vidar-nordli-mathisen-537587-unsplashIn our community, there are two nonprofit community hospitals and one Catholic hospital. All are excellent. Each has slightly different founding values and ways of operating. All three have a strong heart and soul, which has been more or less apparent at different times depending on leadership.

So a recent article exploring the shift in how Catholic Hospitals have approached their values and leadership — and the effect that can have — certainly caught my eye.

Catholic Hospitals used to be run, of course, by nuns. Increasingly, however, as the Fierce Healthcare article describes, “Catholic hospitals are much more likely to be run by lay executives who don’t serve as a human embodiment of religious roots.”

There may be multiple positive aspects of this shift. Perhaps the hospitals are able to serve a broader base of people with a greater diversity of religious backgrounds or values. Perhaps the lay leadership is stronger in some technical aspects of running or managing the hospitals. But the author of this article points out that the shift away from hospitals’ original values “can actually hurt their bottom line, as Catholic hospitals lose the loyalty of community members who sense an erosion of the values that were long integrated into their care.”

In other words, although it may seem that the immediate effect is one of broadening and strengthening, there may be side effects — as of any strong medicine — that outweigh the positives. As the author concludes, we in medicine are in a unique place that is at the intersection of art, science, morality, and human caring. Indeed, “hospitals are seen as more than just a business – they are often seen a reflection of the overall health of a community.”

I don’t have a detailed understanding of the specifics of Catholic hospitals and how these shifts to lay leadership have affected them. That said, I have found on a personal, business, and medical level — that when you dilute or don’t lead with your values, it may seem practical but leads to negative consequences.

Collaboration is about declaring to ourselves and our colleagues that we have a unique perspective, unique skills, and unique values as individual providers. We’re not a generic “healthcare provider” that can be swapped in for any other provider. If that were the case, any provider could provide the same care as any other — and collaboration would be far from necessary.

Let there be no mistaking it: when we lead with our values, and care for patients from our unique set of strengths, weaknesses, and values — we are more interdependent with our colleagues and we end up with a more unique role in the process. For providers who want to see themselves as invincible, this can be uncomfortable. But, as with the example of the hospitals, there may be immediate, short term benefits to diluting our values and trying to be all things to all people — but ultimately, it results in weaker care.

In fact, I think that is one reason that iClickCare, and telemedicine-based medical collaboration in general, is so effective. When we are able to collaborate, to reflect on cases, and to lead (and treat patients) with our values, we get better results. As the article author emphasizes, “There’s benefit in continuing to cultivate the essence of local hospital’s unique personality and roots, even as the benefits of system affiliation are stressed.”

It takes courage to practice medicine from your own unique perspective and strengths, rather than from an imaginary “generic” place. But the rewards are great — and so is the care.

For more stories of courage, medicine, and medical collaboration, download our Quick Guide to Medical Collaboration:

ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration software, hybrid store and forward medical collaboration, good medicine

Is Gun Violence a Public Health Issue Needing Medical Collaboration?

Posted by Lawrence Kerr on Thu, Nov 29, 2018 @ 06:00 AM

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After declining steadily through the early 2010s, gun violence has been rising in the US. Mass shootings, while a very small percentage of total gun deaths, have also risen significantly in the past few years — thus the reason that it feels like we hear about a new shooting every week. Of course, the overall numerical significance of gun deaths may not be as sizable as other causes of death -- but gun deaths remain a killer in our country.

For these reasons, gun violence is sometimes seen as a public health issue. Although not an “unpreventable biological disease,” it is a killer and a factor in the well-being of our citizens. Similar to the opioid epidemic, gun deaths have social, public health, political, and behavioral dimensions. So it makes sense that doctors may have perspectives and concerns about gun violence, especially trauma or ER doctors who are literally on the front lines of battling to save patients who have suffered from a gunshot wound. (That said, the overall deaths from gun violence each year are tiny compared to many other public health problems.)

But a recent kerfuffle highlighted how difficult this topic can be to broach.

As is highlighted in a recent New York Times article, Bronx doctor, Dr. Marianne Haughey was outraged when the National Rifle Associated tweeted: "Someone should tell self-important anti-gun doctors to stay in their lane.”

She replied, "I have cared for victims of gun violence for the past 25 years. THAT must be MY lane." 

The politics and practicalities of gun control and mitigation of gun violence are beyond my sphere of expertise. And the analysis of the relative significance of gun deaths relative to other causes of death is a matter of real research to understand -- not something to address flippantly or scandalize.

But regardless of those more specific questions, for me, the conversation brought up an important question -- what does it mean for a doctor to "stay in their lane"?

What is our lane as doctors, generally, and as individual doctors?

Does our “lane”…

  • End after the last stitch is sewn, as surgeons, or does it extend to stopping by to check on the patient post-surgery?
  • End after we refer a patient to a specialist, or does it extend to following up on their care?
  • Include the societal, social, behavioral, and economic determinants of health?
  • Necessitate medical collaboration, or is seeing a patient during the visit the only job we have?
  • End at the end of our shift?

The answers to these questions have evolved for physicians and healthcare providers over time. And the truth is that there are no right answers. There do have to be boundaries to our sphere of influence as doctors -- both to remain within our expertise and to maintain sanity and efficiency. 

But I think that as a healthcare culture, we've drawn our "lane lines" too narrowly. I do believe that doctors have an important voice when it comes to questions of gun violence. I do believe that surgeons have a responsibility to care for patients long after the surgery is complete. And I believe that medical collaboration is a bare minimum requirement for adequate care. 

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Tags: medical collaboration tool, good medicine

Are Medical Mistakes Linked to a Lack of Medical Collaboration?

Posted by Lawrence Kerr on Tue, Nov 27, 2018 @ 06:00 AM

roman-kraft-266787-unsplashIn a recent New York Times article, Dr. Peskin tells the story of one of her patients — Shirley.

The first time that Dr. Peskin saw Shirley, she had been taking shots on a daily basis to deal with her diagnosis of Multiple Sclerosis.

5 months later, Dr. Peskin saw her again because she had now suffered anaphylaxis from the shots. In the process of treating the anaphylaxis, another doctor ended up reviewing Shirley’s history and concluded that she didn’t have MS at all — indicating that the decades-long course of daily shots were actually unnecessary.

In other words, Shirley’s first doctor made an incorrect diagnosis; that diagnosis was confirmed by a second doctor; and a it wasn’t until a third doctor was involved that the mistake was revealed.

This story certainly isn’t unique. In fact, mistakes are often revealed at the junction point between two doctors — whether it’s during a handoff or because care has been taken up with a new doctor for a different reason.

 

To me, there are three important findings that relate to this story:

  • Mistakes must be part of our medical experience.
    The entire structure of our medical system and practice treats mistakes as an unpardonable, inexcusable part of care. That means that, as Dr. Peskin explains, doctors are left to deal with the intellectual and emotional aftermath of making a mistake on their own. And, I think, learnings from mistakes are limited. Far better would be to incorporate a thoughtful exploration of our mistakes into our practice — in a way that doesn’t necessarily make anyone “wrong” for having made the mistake in the first place. This is one crucial reason that all ClickCare cases are automatically archived and searchable for teaching and reflection.
  • The more we collaborate, the better we do.
    If you collaborate, you don’t need to wait until a mistake is found “after the fact” — another set of eyes (or two or six) can help us make better decisions and diagnoses in the moment.
  • Handoffs are not collaboration.
    It’s important to note that Shirley would likely have received more thoughtful, appropriate care if her three doctors had been able to work together, sharing perspectives. This type of collaboration creates far better, more sophisticated care than simply bouncing the patient between providers. It’s possible that her original doctor had important insights about her that informed the diagnosis of MS — and rather than reversing the original diagnosis, perhaps the final doctor would effect the change by integration or interpolation, while engaging together about the care.

 

Shirley's case didn't end badly, and all of her doctors had been working hard to provide the best care possible. But we believe that a better way is possible, easy, and doable -- if doctors have the right tools and the right mental framework. Doctors don't have to "go it alone" and be infallible -- they can collaborate and they can learn from their mistakes. 

 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: medical collaboration tool, medical mistakes

New Medicare Proposed Rule to Expand Telehealth Benefits

Posted by Lawrence Kerr on Thu, Nov 15, 2018 @ 06:00 AM

rawpixel-487102-unsplashMedicare is a crucial part of our healthcare system. Although some providers feel themselves unwilling or unable to accept Medicare, the reality is that 44 million people are beneficiaries. It impacts those people, as well as our healthcare system as a whole. This is important because the whole healthcare system tends to lean towards Medicare's policies.

So a new proposed rule affecting telehealth is practical, crucial, and fascinating to explore. 

Just recently, Medicare announced a new proposed rule for public comment and review that would greatly expand payment for telehealth. 

The full proposed rule change can be found here, but the general shift leans heavily on Medicare Advantage plans and is summarized as follows: "Under this proposal, MA plans would be permitted to offer – as part of the basic benefit package – additional telehealth benefits beyond what is currently allowable under the original Medicare telehealth benefit. In addition, we propose to continue authority for MA plans to offer supplemental benefits (that is, benefits not covered by original Medicare) via remote access technologies and/or telemonitoring for those services that do not meet the requirements for additional telehealth benefits."

The explanation and rationale for the shift includes this insight: "The healthcare industry has made significant advances in technology that enable secure, reliable, real-time, interactive communication and data transfer that were not possible in the past. Moreover, the use of telehealth as a care delivery option for MA enrollees may improve access and timeliness of needed care, increase convenience for patients, increase communication between providers and patients, enhance care coordination, improve quality, and reduce costs related to in-person care."

Not only is this a powerful positive development for medicare beneficiaries as well as healthcare providers who use telehealth -- we believe this represents an important philosophical shift. Telehealth is not an "an additional benefit" -- it's one of the many tools that healthcare providers have at their disposal to provide excellent care to all patients. This proposed rule is an important step away from that "special benefit" status of telehealth -- and towards it being just one more tool in our toolbox. 

Further, it is recognized that significant savings can come from the use of telehealth, as well as increased access by people who may be in rural, underserved, or hard-to-reach areas.  

The commonsense of telehealth seems to be slowly eroding the granite barrier of Medicare’s policy toward payment for telehealth.  As you know, there are significant restrictions about who, where and how a patient could benefit from technology applied to day-to-day care. Currently, live video conferencing from specific sites is the only reimbursable use of telehealth for Medicare recipients. We, of course, are strong believers in using technology to shift time as well as shift place. Hybrid Store-and-Forward Telemedicine®, for instance, uses asynchronous collaboration -- you respond on your own schedule -- so that both the patient and provider can solve problems without always using expensive hardware and having the interruption of scheduled appointments.

We understand CMS’s concerns about the potential for fraud and agree with the concerns. However, in our modern society with a fragmented health care system, collaborative and coordinated care has benefits that outweigh the risks.

For providers who care about good medicine and thoughtful healthcare, this new rule is an important development -- and likely shows the direction that reimbursement and medicine in general is headed. 

 

To learn more about Hybrid Store-and-Forward Telemedicine, including reimbursement issues, download our white paper: 

 ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: hybrid store and forward medical collaboration, telemedicine reimbursement

What Helps Doctors Understand Patients' Stories?

Posted by Lawrence Kerr on Thu, Nov 08, 2018 @ 06:00 AM

vlad-bagacian-634061-unsplashStories are sewn into every part of medicine. 

The way we are trained to talk to patients is about drawing their story out of them. The way we share cases with colleagues is about describing the narrative of a patient. 

But modern medicine, especially in this age of EHRs and silos, tends to reduce patients to treatments and boils stories down to a series of interventions. And this weakness might feel more "efficient" at first but does tend to erode the quality of care our patients receive -- as well as the results they may experience from that care. 

That said, there are programs and tools that intend to reintegrate patient stories into our work. A recent article in the New York Times told of a program at Weill Cornell Medicine in New York. To combat ageist biases and practices, the program brings in older people to speak to medical students about their experience. Like all people, older patients have a diversity of experiences, strengths, and challenges. And for doctors to care for them well, they need to be able to understand this diversity, and create a care plan within that knowledge. 

As Dr. Adelman, the coordinator of the program, says, "Unfortunately, most education takes place within the hospital. If you’re only seeing the hospitalized elderly, you’re seeing the debilitated, the physically deteriorating, the demented. It’s easy to pick up ageist stereotypes.”  This program aims to complement this more hospital-based perspective with the other facets of patients' experiences. 

Unfortunately, this type of program is still rare. And rarer still are tools that support the full, holistic story of patients as the center of care -- especially once healthcare providers are outside of an academic setting and in the flow of practice. 

Electronic Medical Records, text messaging, and other intervention-focused tools only serve to create a further lack of "story" in patient care. But when you don't have the full story of a patient -- including their dreams, goals, daily habits, health goals and other "ancillary" aspects -- you don't necessarily have the full picture of how best to treat them. 

Certainly, many aspects of medicine pull us, as providers, away from stories and towards interventions. But when we use a telemedicine-based medical collaboration tool -- like iClickCare -- to have fulsome conversations with other providers about patients and share the holistic picture of whom the patient is, we provide better care and experience more satisfaction. So whatever our medical education provided or did not provide in this way, we always have the choice to use tools to practice medicine in the way that best fits our values. And for me, that has meant a tool that helps me do medical collaboration and see patients as full people. 

 

Tags: healthcare collaboration, medical collaboration software

Health Care Power-Users Point to Collaboration as Key to Care

Posted by Lawrence Kerr on Tue, Nov 06, 2018 @ 06:00 AM

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Frequently, “power users” of healthcare are seen negatively.

Whether because they are seen as more “demanding” patients or because of their relatively larger “burden” on the healthcare system, there is often a bias against these patients.

But a recent study — a collaboration among the New York Times, The Commonwealth Fund, and the Harvard TH Chan School of Public Health — looked in depth at these patients, both putting a spotlight on their behavior and experience, as well as sharing the wisdom they have about how to interact effectively with the healthcare system. Interestingly, much of what they shared advocated for a more collaborative, connective way of doing medicine.

In this study, “power users” of healthcare are defined as “people who have been hospitalized multiple times and are seeing multiple physicians, related to a serious illness, medical condition, injury, or disability.”

Of course, their perspective holds a lot of important insights for healthcare providers, for a few reasons. They: 

  • Have experienced more facets of the healthcare system. 
  • Necessarily developed skills and habits to deal with the shortcomings and strengths of the system. 
  • Are sicker and so may tax the system more, revealing faults that go less noticed otherwise. 

So this study of their experience, problems, and advice is enlightening. Among the findings: 

  • 30% say they were sent for duplicate tests by different healthcare providers.
  • 23% have had to wait too long for appointments, treatments, and tests.
  • Overall, they offer the following advice for navigating the medical system:
    • Show your doctor a list of medications you are taking (78%)
    • Bring a list of things to discuss with your doctor (70%)
    • Bring a family member, friend or someone else to all of your medical appointments to serve as a coordinator (55%)
    • Seek advice or help from a family member or friend who is a doctor, nurse or other health professional (34%)
    • Seek advice or help from a former patient who had a similar health condition (23%)

 

Our take on these results? People who use the medical system a lot experience the delays, confusion, and duplication caused by healthcare providers that aren't able to coordinate care or do healthcare collaboration. For that reason, the advice these patients offer tends to revolve around creating their own solutions to ensure care coordination on their behalf.  

Instead of patients trusting doctors and other providers to coordinate care, they do it themselves or involve friends or relatives to support them in doing it. This behavior certainly makes sense. And it's a wise way to approach a well-intentioned system that doesn't always work. But it does concern us, since patients have only a limited ability to truly coordinate care on their own behalf. For instance, a patient can bring a list of medications they are taking, but they can't bring a list of providers who should collaborate on a case. They can ask a friend to offer advice, but they can't necessarily facilitate meaningful conversations among all of the members of their care team. 

That's why we believe it's necessary for healthcare providers to have the tools they need to truly effect care coordination and healthcare collaboration. Sure, patients may fill in the gaps. But their ability to identify all of the possible gaps and truly fill them effectively is limited.

 

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Tags: healthcare collaboration, care coordination, medical collaboration tool

One Simple Thing that Makes Patients Happier & Drops Healthcare Provider Burnout

Posted by Lawrence Kerr on Thu, Nov 01, 2018 @ 06:00 AM

rawpixel-674079-unsplashMost doctors I know can’t conceive of doing any more of anything.

Their patient visit slots are completely maxed out. Lunch is nonexistent. Every day, it seems like managers and administrators have a new request, demand, or memo to share about yet another thing that must happen during the visit, during the workday or at home.

So a recent article in Fierce Healthcare made me both nod in recognition and cringe with concern.

The takeaway of the article is that patients wished their doctors would talk to them about — and perhaps even support them with  more non-medical or quasi-medical issues. The Harris Poll surveyed over two thousand adults. Those adults shared that doctors (of course), tend to focus on physical health, even though the most common health issues were actually depression, anxiety, chronic pain, and diabetes. According to the poll, however, doctors touched on the mental, behavioral, or spiritual components of health, less than half as frequently (sometimes as little as 10% of the time), as more cut-and-dried physical components of health.

Of course, these “soft” elements — mental, behavioral, or spiritual components of health — are often the things (like exercise, sleep, etc) that can prevent illness or treat chronic conditions. Also, they often relate more intimately to issues like addiction or suicide which are, of course, epidemic in the US. So it could be deeply helpful to patients if doctors were able to broach more of these subjects.

“With what time?!”  I can hear doctors exclaiming in my head. I know from experience that within the visit time allotted by our bosses and by the healthcare industry, it’s difficult to cover even the basics of the patient's complaint and to satisfy all of the EMR’s buttons and requests. When we read an article like this, we feel like one more thing is being demanded from us that may as well just be deducted directly from our sanity.

Interestingly, an article in the New York Times that came out around the same time looked at doctor burnout and may indicate different conclusions. Dr. Mukherjee reminds us that burnout can be predicted by three things (termed the “Maslach Inventory”):

  • Emotional exhaustion (being “chronically overextended”)
  • Depersonalization (“becoming disconnected from the recipient of your services”)
  • Lack of personal accomplishment “a feeling that nothing is being achieved.”
I think many of us tend to talk about and experience the first one — that of being chronically overextended. But the truth is that depersonalization and lack of personal accomplishment are equally important to remaining satisfied and having longevity in our work.

Ironically (or perhaps predictably), the very things that our patients want more of from us — more engagement, more deep interaction, more holistic care — are the very things that would keep us from getting burned out. And so perhaps there is a bit of a chicken-and-egg situation. We feel overworked (emotional exhaustion), so we pull away from the personalization and sense of personal accomplishment that would keep us from getting drained. In the process, we miss the very things that could treat our patients more meaningfully.

It's true that most elements of the medical system right now do not support us in this pursuit. Productivity metrics, EMRs, and decreasing visit times all hinder us in this kind of approach. But the truth is that we still have the autonomy to take an extra 45 seconds and ask that softer question. Or to try a new medical collaboration tool for a week, if we think it would help us feel supported by our colleagues and give us some followup. The changes, perhaps, don't need to be as dramatic as one might initially think -- to be deeply satisfying to both our patients and to ourselves.

 

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Tags: good medicine, healthcare provider burnout

Believe It or Not, There is a Human Behind Every Part of the Healthcare System

Posted by Lawrence Kerr on Fri, Oct 19, 2018 @ 06:00 AM

rawpixel-600792-unsplashMy daughter has a particular pet peeve. She’s noticed that in so many movies, when there is a doctor in the story line, he or she (usually he) tends to be arrogant, insensitive, and uncaring — in so many ways, inhuman.

As doctors ourselves, we tend to see our colleagues — whether doctors, nurses, or aides — as very much human because we know them and interact with them every day. But it’s easy to see insurance carriers or drug companies or other parts of the healthcare system as faceless monsters that make our patients’ lives difficult.

Which is why I was really interested to read a series of articles that turned all of that on its head, and definitely warmed my heart.

A couple of weeks ago, Gina Kolata wrote an article in the New York Times about the new class of drugs, PCSK9 inhibitors, that slash cholesterol levels for patients that aren’t seeing results on statins, or with diet or exercise, but have serious risk of early heart attack or stroke.

She told the story of the hyper-expensive drugs, the $14,000 price tag that the drug manufacturers have set, and the insurance carriers that create a byzantine maze for any patients trying to access the drug.

It’s a well-known story — evil drug companies and evil insurers make it impossible for patients to access the care they need. When I read it, I didn’t think much of it.

Then, about a week later, another story came out.  In this one, the New York times reporter tells a story that pretty much upends all of my assumptions about the players in the story.

The evening her story was published, the founders of Regeneron — the manufacturer of the PCSK9 inhibitors — emailed her.  Dr. George D. Yancopoulos and Dr. Leonard S. Schleifer wrote:

“If you can, please put Mackenzie and Rodney in touch with us, and we will try and help them get covered, or we can arrange to give them the drug for free… While we can’t give everyone free drugs, we can help Mackenzie and Rodney, especially as they had the courage to step forward and share their experiences.”

He then gave his personal phone number and asked the journalist to give it to the patients in the story, “explaining that he can be slow answering emails.” 

In her story detailing her conversations with Dr. Yancopoulos, Kolata told the story of Regeneron. It was founded by the two doctors in 1988. 20 years after that, Regeneron got its first drug approved. 5 years after that, they made a profit. 25 years of a business isn’t exactly a “get rich quick” scheme. The total cost to develop the drug was $1.6 billion and last year they made just $195 million (a tiny fraction of the total investment.) In reading the article, it's clear that Dr. Yancopoulos has battled for decades to create a drug that he truly believes will save lives -- and that his heart is very much invested in making sure people have access to it.

Certainly, it's great that these two patients got access to the drug -- although that doesn't change the challenges that most patients will encounter in obtaining it. That said, it's a fascinating article and shows that even the most "inhuman" elements of the healthcare system -- for instance, drug manufacturers -- may have real people behind them who are doing their best to chart a course forward in a challenging system. 

The truth is that none of us are as smart as all of us, working together, are. (We say that a lot.) And for us all to work together, we must continue to see everyone in the healthcare system as human. 

 

ClickCare Quick Guide to Medical Collaboration

Tags: healthcare collaboration, medical collaboration

Medical Collaboration has More Regulatory Flexibility than Direct-to-Patient Telehealth

Posted by Lawrence Kerr on Thu, Oct 18, 2018 @ 06:00 AM

victoria-heath-367303-unsplashAs the world changes, our regulations and laws often scramble to keep up.

Whether it’s Uber being challenged in individual cities or schools struggling to adapt to children owning cellphones, the legal side of life often lags behind our technology, our culture, and our needs.

So it shouldn’t be surprising that telehealth regulations face similar challenges across states — but the consequences are indeed challenging for those who do direct-to-patient telehealth.

A recent article in Fierce Healthcare looked at a few examples of recent telehealth challenges arising from state-to-state regulatory differences.

As they report, “Whether a medical professional can treat someone via telehealth—and if so, how—varies widely by jurisdiction, since medical practice is regulated at the state level.”

For instance, court cases involving doctors seeing patients via telehealth touched on:

  • The administration of medical abortions
  • Prescription of controlled substances
  • Etc.

Further, doctors and patients often run into challenges when the intended telehealth patient didn’t have access to the Broadband internet needed to access an electronic visit with a doctor (thus limiting care in the very places that telemedicine could be most useful.)

These challenges are real, and important to explore. That said, it's not necessarily the case that the challenges are inherent in using telemedicine across state borders.

The regulatory issues presented in the Fierce Healthcare article all boil down to the challenges inherent in a doctor seeing a patient electronically.  But “telehealth” is NOT synonymous with doctor-to-patient online visits. As we’ve written about extensively, the umbrella term "telehealth" includes the use of many different kinds of technology to care for patients. A doctor seeing a patient via an online platform is only one version of that.

In fact, the challenges of videoconferencing or electronic visits are the very reasons that we created iClickCare to revolve around medical collaboration among healthcare providers, NOT between a single medical provider and a patient. There are many reasons that a short, technology-supported visit between a healthcare provider and a patient via videoconferencing may not be adequate to provide strong, holistic care of that patient. There isn't a useful archive of the visit; other members of the care team can't be involved; there is often little longitudinal knowledge of the patient; and care is infrequently holistic. The regulatory issues inherent in a “visit” like that are only one aspect of the shortcomings involved.

As an alternative, telemedicine-based medical collaboration allows providers — regardless of location — to collaborate on a case. It also means that if a provider in California is consulting with a provider in New York about a patient in California, the provider in California remains responsible for that patient. And that is “responsible” in all senses, legally and otherwise. Telemedicine-supported medical collaboration allows the flexibility and location independence that telehealth promises. But it doesn’t put the sole responsibility for a patient in the hands of a provider who is 300 miles away and has interacted with them, once, on Skype.

As we step forward into this new age of telehealth, telemedicine, and technology, it's important that we don't simply replace our old system (one-on-one doctors' visits, for instance) with a technological version of that old system. Our patients deserve more imagination than that. And we deserve the ease that can come from a tool that really works to help us deliver great care. 

 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: hybrid store and forward medical collaboration, medical collaboration tool, telehealth and hipaa

Is an In-Person Visit Always Preferable to Telehealth Options?

Posted by Lawrence Kerr on Thu, Oct 11, 2018 @ 06:00 AM

rawpixel-743067-unsplashA new article in the New England Journal of Medicine takes a controversial stance on the topic of whether an in-person doctor's visit is always "Plan A."

Perhaps, the author argues, we are moving towards a time when patients will be better served by a model in which in-person visits are actually the "last resort" of care. 

Our take? Yes and no. Read on...

In "In-Person Health Care as Option B", Sean Duffy and Dr. Thomas H. Lee advocate for a new framework for healthcare visits. Rather than seeing telehealth visits or other virtual options as "in the meantime" approaches or ways to cut costs, they argue that perhaps patients can be cared for better when in-person visits become much rarer, only used when absolutely necessary.   

They describe the analogy of a tech support ticketing system, as might be used at your favorite software company. Perhaps a patient would submit a "ticket" with their concern or medical issue... it would be handled first via telehealth means (even automated or low level support at first)... only being "escalated" to an in-person visit if absolutely necessary. And the ticket wouldn't be closed out until or unless the initial complaint was resolved.

The technology is there, the authors contend. “Smartphone penetration of the mobile-phone market increased from 17% to 81% between 2009 and 2016.” And the reality is that in many ways, our medical system is already moving in this direction: "At Kaiser Permanente, for example, 52% of the more than 100 million patient encounters each year are now “virtual visits.”

One important point that the authors make is that doctors are often approaching care this way currently -- but with improvised methods that aren't really meeting the provider's or the patient's needs. True enough: “Virtual visits are more convenient, but there’s a difference between recreating an in-person approach with digital tools and designing the safest and most efficient way to achieve an optimal outcome." Further, if doctors are simply using text messaging, email, or informal photos to replace a visit, that's not a safe or sustainable way to replace the richness and HIPAA-compliance of a real visit. Also, improvised approaches tend to be lesser replacements for in-person care, rather than innovative ways to save money AND get a better result.

Although we agree that there is a lot of potential to rethink how we approach clinical visits in healthcare, we also worry that the authors' approach isn't appreciating some of what can be lost if telehealth approaches aren't designed thoughtfully.

For instance, the example of the tech support "ticketing" analogy would fall severely short of our goals for any medical visit. Sure, the patient's complaint needs to be addressed. But medicine is more complex than software.

So any approach to increasing the use of telehealth solutions also must:

  • Support medical education.
    This means that simple videoconferencing or "e-visits" likely aren't sufficient, as they don't create an archivable, searchable, teachable record of the encounter.

  • Provide holistic care to the patient. 
    Support not just solving the immediate problem, but truly caring for the patient -- which doesn’t always just mean solving only the problem the patient presents with.

  • Enable providers to collaborate effectively.
    It would be a tragedy if telehealth caused a further silo-ing of providers across specialities and across the continuum of care.

Healthcare needs innovation, certainly. And technology will be a crucial part of any solution that stands a chance of survival moving forward. But we advocate for approaches that truly support access, education, and collaboration -- not just completing a ticket and checking off a box for a patient.

 

To learn more about alternative technologies for telehealth, download our Quick Guide to Hybrid Store and Forward Telemedicine®: 

 

ClickCare Quick Guide to Hybrid Store-and-Forward

 

 

Tags: hybrid store and forward medical collaboration, telehealth and hipaa

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